The hemodialysis patient is captive in his treatment environment for extended periods of time; however, little attention has been given to the quality of the environment where that care is given. The purpose of this study is to investigate what effect dialysis facility design has on the effectiveness of treatment indicated by the dialysis patients compliance with life-saving medical treatment and on the staff s efficiency indicated by absenteeism and turnover. We hypothesize that design features will affect the level of stress/well-being and self-efficacy/helplessness of both patients and staff, and in turn, affect patient and staff outcome behaviors of compliance and absenteeism/turnover, respectively. We propose a two-year study of all dialysis units within 3 regions of Network 14 (Regions 5,6, & 11 in Texas; N=69 units, 3274 patients) to evaluate each unit's design features concerning control and esthetics; unit size, type, and organizational characteristics; and absenteeism/turnover rates per unit. Record review of consenting patients will be conducted to identify patient's compliance behavior and demographic characteristics. Questionnaires will be administered to assess patients' and staff s perceptions of design considerations and of their compliance and absenteeism behavior, and reported measures of stress and self-efficacy. This study will provide the first systematic analysis of dialysis unit design and associated factors of patient treatment compliance and of staffing patterns of absenteeism and turnover.